• Article
  • November 7, 2018

How This Hospital Decreased CLABSI Rates and Reduced Nursing Turnover

Give new and experienced nurses the training they need to provide the best patient care.

Medical University of South Carolina (MUSC) Children's Hospital in Charleston made changes to how it delivered nursing education and over time discovered some unexpected results. The hospital had moved from using unit-based educators to a centralized, clinical education department, but that switch was followed by high turnover rates and a lack of clinical experts at the bedside.

"There was also poor succession planning for the clinical experts in nursing—the average age of practicing nurses is 50, so what are we going to do in 10 to 15 years as they start retiring?" says Melinda Biller, M.S.N., M.S.W., RN, CCRN, NE-BC, nurse manager, MUSC Children's Hospital. There was also a lack of standardization in practice, and little to no support for staff to continue to learn and grow after an initial orientation period.

The hospital's plan to improve clinical knowledge, reduce turnover, yield better patient outcomes and provide better care, which was outlined at Children Hospital Association's 2018 Annual Leadership Conference, was to use high-performing, clinical experts with advanced education and training to facilitate continuous learning opportunities.

To do this, the hospital piloted a clinical practice nurse expert (CPNE) program in units with high turnover, negatively trending quality data and a low culture of safety. In her role as the clinical expert in specialty care in the hematology/oncology unit, Ashley Varnes, M.S.N., RN, CPHON, CPN, BMTCN:

  • Examines trends, gaps in knowledge and practice, and validation of clinical practice after orientation and education on other interventions
  • Collaborates with the interdisciplinary team to assess global learning needs
  • Partners with clinical educators from the education department to assist with organizational learning requirements, annual competencies and support program development
  • Sets yearly goals related to specific clinical work and initiatives

"I prepare and carry out curriculum which includes clinical and didactic learning experiences; and serve as a mentor to nurses in specialty areas and a point of contact for members of interdisciplinary teams to bring questions, concerns or ideas," Varnes says.

The program is seeing positive results in improved clinical care and reduced nursing turnover. Biller says after starting the program in January, the pediatric hematology/oncology unit decreased central line-associated bloodstream infections (CLABSI) by 62 percent and decreased rates of hospital-acquired C. difficile infections by 50 percent. In the pediatric emergency department, nursing turnover decreased by 5.6 percent.

Plans include expanding the CPNE program across the organization by strategically adding units with high turnover or low trending quality data.

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